The journal article critically analysed herein is “Responding to the financial abuse of people with dementia: a qualitative study of safeguarding experiences in England” by Jill Manthorpe, Kritika Samsi and Joan Rapaport .
The article is laid out in the traditional manner (“Abstract, Introduction, Methodology, Results, Discussion and Conclusion”). As a result, my analysis will follow the same structure and consider the article in light of its designated sections.
Abstract
The abstract is set out in paragraphs and provides a concise overview of the research to follow. It identifies the research problem (ie the need to obtain the views of adult-safeguarding professionals in relation to financial abuse of dementia patients), and sets out in summary the methodology used. Under “Results”, the abstract, rather than summarising the results in broad strokes, simply sets out the themes identified. Under the heading “Conclusions” it then states the recommendations it draws from the research undertaken. Whilst it might have been slightly more forthcoming with its summary of the results, this is overall a helpful abstract that draws the reader in.
Introduction
The introduction contains the literature review. This section provides the background to the research in relation to financial abuse among dementia sufferers, by examining and evaluating other research in the area.
The authors first of all consider recent research that highlights the financial risks to people with dementia, setting out also the limitations identified in those studies, especially around evidential procedures (“There is particular difficulty in obtaining prevalence estimates of financial abuse…” ). This shows that the researchers have considered how their study will fit into the current body of knowledge. It also demonstrates the researchers’ awareness of the difficulties they may encounter.
The article also identifies previous research on risks to dementia patients that do not include financial risk and criticises those studies for the absence of that element (“This is worrying as …” ). In highlighting these articles, the authors, by implication, inform the reader of the impact they hope their study will have in contrast.
The authors also provide information at this stage on the law itself and the difficulties of identifying if financial abuse is a criminal offence, stating government guidance on the topic . This helps put the matter into its legal context.
Finally, the introduction concludes that this study fills a void with respect to information needed on financial abuse, by learning directly about the “views and experiences” of those professionals dealing directly with financial abuse situations in relation to vulnerable adults (and focusing on adults with dementia). Again, relevance of the study is clearly stated.
Overall, the introduction is well structured and flows clearly. It sets out a well-balanced selection of recent articles that relate to the topic. The aim of the study is clearly set out (“this study is the first to report adult safeguarding professional experiences about financial abuse among people with dementia in the context of specific legislation” ), and suggests practical goals of how the results may be used (“explore barriers and facilitators in minimizing risks” and “These English experiences […] may be relevant elsewhere […] [i]n the USA, for example”) .
Methodology
The methodology section aims to explain how the research was carried out and overall does so well. However, it is less clear in its explanations why the described methodology was chosen and applied in the specific manner.
The article does not provide information on the researchers thoughts on underlying epistemological or ontological approaches. The reader is left to infer this from the data collection methodology and analysis. It might have been helpful to set out explicitly on what basis this research was conducted.
The authors explain that 15 participants were interviewed. However, they do not clarify why the sample was restricted to a number of 15. Was this due to a lack of participants agreeing to take part, was this due to saturation of information after 15 interviews, or were there other constraints or reasons? This sample size appears fairly small in view of the number of relevant council employees that might have been willing to participate.
Another interesting element that could use further clarification relates to the way in why sampling was undertaken. The authors rejected “theoretical diversity” in favour of “a purposeful sampling approach aiming for representations of this diverse professional group” . This is an interesting statement, as the authors had not previously made any reference to grounded theory, which is where we would usually find reference to theoretical sampling . In addition, in describing their sampling choices, the researchers might have been more precise in their explanation, setting out if the diversity sought was in relation to gender, age, race, cultural background, educational background, experience on the job and/or other factors. Such details might have been a helpful addition to the article, giving readers a clearer understanding of whom the interviewees represented.
The interviews were conducted in a structured format. To ensure transparency of the questions asked, the full interview schedule is set out in the article. This is very helpful and allows for a clear understanding of the issues that were covered during the interviews with the professionals, as well as any elements that were omitted. It would also allow for the study to be replicated faithfully if required.
The article also explains in detail how the questions were selected, providing further transparency on the researchers’ aims. In this case, the content of the interview was formed from experience gained whilst interviewing an overlapping sample of similar professionals on a related topic (ie the Metal Capacity Act and the professionals’ “expectations” and “emerging experiences” relating thereto), as well as speaking to the Alzheimer Society about experiences in practice that they had been made aware of.
As a result, the data asked appears to be appropriate in relation to the research problem asked. However, it might have been useful to switch the order of the questions somewhat. I would contend that Question 2 , on how to define financial abuse, might have been most useful as the very first question, so that it was clear from the outset what a participant meant when taking about financial abuse, such as in the context of the frequency of financial abuse, for example (Question 1 in the study). The questions also explore the participant’s opinions and experience in a multitude of ways, covering when financial abuse might be suspected, how it is dealt with and what actions/processes are available to them. Closing the interview with a ‘catch-all’ open question (“is there anything else you would like to add?” ) ensures the views and experiences of the professional are adequately captured.
Setting out succinctly the ethical process followed relating to consent, confidentiality, anonymity and ethical approvals obtained, shows the authors’ understanding of the requirements in this regard.
There is no explanation why individual interviews were considered the most appropriate form of obtaining the required data, other than that the researchers thought this method was helpful to “facilitate research participation by busy professionals” . Might the same or more complete information have been obtained through questionnaires or focus groups? The researchers have described each interview to have lasted between 45 minutes and an hour and to have been conducted via telephone .
It is possible to speculate that this method, whilst time-consuming, might have yielded the best results in terms of participation and data collected:
With a lengthy questionnaire, a number of factors might play against a satisfactory return of answers. Employees might find it difficult to devote the necessary time to a non-job-related task when no specific time was scheduled. Employees could be distracted when completing the questionnaire alone without a researcher prompting them. Questions might not be understood clearly. Focus groups, whilst they might have the potential to allow for fruitful conversations, might have been difficult to set up, given that the sample was purposefully selected to include participants from a wide geographical area (“London, southern, eastern and north-west England” ).
Method choice could have been clarified in the article.
In contrast, the methodology surrounding analysis is clear, identifying the steps undertaken by the researchers , which ensures the final conclusions are based on the researchers’ correct understanding of important issues. This, contrary to the sampling description and data collection methodology, is highly detailed, effectively providing a clear ‘how-to guide’.
Results
The results of the study are presented around five themes identified following the interviews. This allows for answers from various interviewees to be pooled together and for answers on same topics to be viewed side by side, in a comparative manner.
The authors refrain from drawing conclusions from their findings at this stage. They clearly only aim to set out concisely the results that were gained from the interview process. Using numbers to refer to specific interviews conducted, either ideas are represented or phrases are quoted to highlight specific information. In some cases the authors use lists in bullet-point format to enumerate a number of different elements considered by the interviewees (such as a list of prevention measures taken ).
It might have been helpful to present some of the results using visual methods, such as graphs, diagrams or tables, to present the findings more clearly and highlight the frequency with which some data items where recurring.
Discussion
In the introductory paragraph of this section, the authors analyse the answers and draw their consequences from the results set out above. However, the researchers were not able to relate their key findings set out under ‘Results’ to the research referred to it the earlier literature review. Instead, they highlight aspects of policy that work well and consequently recommend them as an element to take into account in other countries (“the interviews revealed confidence in LPAs… this may be a policy option for other countries.”) . They also underline issues that have come to light because of the data provided.
The researchers specifically analyse their own findings’ strengths and weaknesses, setting out the limitations that arise due to the limited amount of participants, which therefore might not represent the majority of similar professionals in their views . They also highlight as a weakness the conducting of interviews over the telephone rather than face-to-face . By highlighting these issues, the researchers show great awareness of underlying issues that may reduce the impact of their study somewhat. Then, to counterbalance these limitations, the authors highlight the strengths of the study as being conducted with experts with therefore greater knowledge , and therefore “were able to compare and contrast cases involving people with dementia with those of other people at risk”. Whilst knowledge of experts is very useful, I would contend that data from ‘ordinary members of the public’ might also have shed light on issues debated in this study, although of course in that case the aim of the study would have had to have been modified somewhat.
The research is not expressly framed by any theoretical framework. However, it might be possible to state that implicitly the researchers advance the theory that dementia patients are more vulnerable to financial abuse. However, the authors do not further develop this theory. Instead, this is a helpful piece of ‘law in action’, demonstrating what a specific selection of the population have experienced. Rather than expressing a critique of the current system in place, the article retains a highly descriptive quality. This article however might have benefitted from positioning the law in context, such as the context of vulnerability or solidarity . In doing so, the authors might have been able to go beyond the descriptive and consider how the answers could be analysed in that context.
The validity of the study is confirmed by the various strategies adopted in this case. Firstly, the study was conducted with multiple researchers, ensuring the study is not tainted by the views and opinions of a single researcher. Also, the answers obtained from the sample group were checked prior to being used in the analysis . However, to enhance the credibility even further, the authors might have considered using combined methods (such as quantitative or other qualitative methods), and thus triangulating their results to demonstrate the validity of the outcomes.
This article is very good at identifying impact and relevance of the study in the wider community. In this case, it is identified as providing more information about this rarely explored topic on financial abuse. Both by referring back to other authors mentioned in the prior literature review, and by highlighting how their research affects other research (either by confirming or extending its information provided), the authors show the impact their research can have.
Conclusion
This piece of research is very effective, instructive and impactful. The results and analysis are well considered and thoughtfully explained. Using various validity checks ensures the reader can be confident of the results and discussion submitted. The article may have benefitted from a clearer description of sample recruitment considerations and sample size, as well as from a clearly defined context in which to place the study. Overall though, this article looks to be beneficial and have impact for healthcare professionals, social workers, policy makers and the research community looking at the situation of dementia patients in our society.
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